Anterior cruciate ligament injuries in the sports population are very frequent, each year in Italy tens of thousands of them occur with a higher incidence every year. The reconstruction of the anterior cruciate ligament using a graft is the most common tool to recover the fuction, months of rehabilitation follow with particular focus on preventing the atrophy and on recovering the strength of the quadriceps muscle. A promising technique that does not place significant shear stress on the knee joint and on the newly operated ligament is Blood Flow Restriction training (BFR). Controlled vascular occlusion is used in combination with low load resistance training; some studies have shown that it is capable of improving strength gains similar to heavy load resistance training but withouth irritating the recently repaired structures. The hypothesis formulated is the following: resistance training with vascular occlusion (BFR-RT) can result in an increase in trophism and strength and a reduction in pain if compared to the conventional physiotherapy treatment in the population undergoing anterior cruciate ligament reconstruction. BFR can provide gains in mass and strength withouth creating significant damage to muscle fibers as opposed to exercises with high overloads and given the possibility of performing the exercise at a reduced intensity it can result in a lower stress on the neo-ligament. A literature review has been performed using the main search engines databases (PubMed, PEDro, Cochraine Library) and including articles from the last 10 years that have considered the use of BFR in the rehabilitation after anterior cruciate ligament reconstruction. The results obtained were then filtered using inclusion and exclusion criteria and as well boolean search terms in order to find the best possible scientific evidence, for this reason it was decided to use randomized clinical trials and systematic reviews. It turned out that BFR-RT was as effective as HL-RT in increasing strength and more suitable in improving physical function, reducing pain and swelling in anterior cruciate ligament reconstruction patients. It has been seen that its application is more suitable for the patient during the early stages of postsurgery rehabilitation, this supports its use in rehabilitation. Many of the physiological mechanisms that can be observed are not yet fully explainable therefore more studies are needed before BFR can be implemented in clinical practice.
Le lesioni del legamento crociato anteriore nella popolazione sportiva sono molto frequenti, ogni anno in Italia se ne verificano decine di migliaia, con un’incidenza ogni anno maggiore. La ricostruzione del legamento crociato anteriore tramite un innesto è l’intervento più comune per recuperare la funzione, seguono mesi di riabilitazione con una particolare attenzione alla prevenzione dell’atrofia ed al recupero della forza del muscolo quadricipite. Un approccio promettente che sembra non porre stress di taglio significativi sull’articolazione del ginocchio e sul legamento appena operato è il Blood Flow Restriction training (BFR), si utilizza un’occlusione vascolare controllata in combinazione con un allenamento di resistenza a basso carico. Alcuni studi hanno dimostrato che il BFR è in grado di fornire guadagni in forza simili all’allenamento contro resistenza ad alti carichi senza tuttavia irritare le strutture recentemente ricostruite. L’ipotesi formulata è la seguente: l’allenamento di resistenza con occlusione vascolare (BFR-RT) può comportare un aumento del trofismo, della forza e una riduzione del dolore comparabile se non maggiore, al trattamento fisioterapico convenzionale nella popolazione sottoposta ad intervento di ricostruzione del legamento crociato anteriore. Consente guadagni in massa e forza senza creare danni rilevanti alle fibre muscolari provocati dagli esercizi con sovraccarichi elevati e inoltre data la possibilità di eseguire l’esercizio ad un’intensità ridotta si ha un conseguente stress inferiore sul neo-legamento. È stata eseguita una revisione della letteratura tramite l’utilizzo dei motori di ricerca delle principali banche dati (PubMed, PEDro, Cochrane Library) includendo articoli degli ultimi 10 anni che hanno preso in considerazione BFR nella riabilitazione dopo ricostruzione del legamento crociato anteriore. I risultati ottenuti sono stati poi filtrati utilizzando dei criteri di inclusione ed esclusione nonché termini di ricerca booleani al fine di individuare la migliore evidenza scientifica possibile, per questo motivo si è scelto di utilizzare trial clinici randomizzati e revisioni sistematiche. Ne è emerso che BFR-RT si è dimostrato efficace tanto quanto il HL-RT nell’incrementare la forza e più adatto nel migliorare la funziona fisica, nel ridurre il dolore e il gonfiore nei pazienti operati di ricostruzione del legamento crociato anteriore. Si è visto che la sua applicazione risulta più adatta per il paziente durante le prime fasi di riabilitazione post-chirurgia, il che supporta il suo uso in riabilitazione. Molti dei meccanismi fisiologici che si possono osservare non sono ancora del tutto spiegabili pertanto sono necessari ulteriori studi prima di poter implementare BFR nella pratica clinica.
Il Blood flow restriction training come strumento riabilitativo nei pazienti operati di ricostruzione del legamento crociato anteriore: revisione della letteratura
SPERANDIO, SIMONE
2021/2022
Abstract
Anterior cruciate ligament injuries in the sports population are very frequent, each year in Italy tens of thousands of them occur with a higher incidence every year. The reconstruction of the anterior cruciate ligament using a graft is the most common tool to recover the fuction, months of rehabilitation follow with particular focus on preventing the atrophy and on recovering the strength of the quadriceps muscle. A promising technique that does not place significant shear stress on the knee joint and on the newly operated ligament is Blood Flow Restriction training (BFR). Controlled vascular occlusion is used in combination with low load resistance training; some studies have shown that it is capable of improving strength gains similar to heavy load resistance training but withouth irritating the recently repaired structures. The hypothesis formulated is the following: resistance training with vascular occlusion (BFR-RT) can result in an increase in trophism and strength and a reduction in pain if compared to the conventional physiotherapy treatment in the population undergoing anterior cruciate ligament reconstruction. BFR can provide gains in mass and strength withouth creating significant damage to muscle fibers as opposed to exercises with high overloads and given the possibility of performing the exercise at a reduced intensity it can result in a lower stress on the neo-ligament. A literature review has been performed using the main search engines databases (PubMed, PEDro, Cochraine Library) and including articles from the last 10 years that have considered the use of BFR in the rehabilitation after anterior cruciate ligament reconstruction. The results obtained were then filtered using inclusion and exclusion criteria and as well boolean search terms in order to find the best possible scientific evidence, for this reason it was decided to use randomized clinical trials and systematic reviews. It turned out that BFR-RT was as effective as HL-RT in increasing strength and more suitable in improving physical function, reducing pain and swelling in anterior cruciate ligament reconstruction patients. It has been seen that its application is more suitable for the patient during the early stages of postsurgery rehabilitation, this supports its use in rehabilitation. Many of the physiological mechanisms that can be observed are not yet fully explainable therefore more studies are needed before BFR can be implemented in clinical practice.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/38700